There is no single CPT code available to report all the components of a typical cervical/vaginal pap smear. Here is a brief summary of some of the more common services a pathologist or lab might provide.
Cytotechnologist Screening Services When a laboratory receives a cervical/vaginal pap smear for evaluation, the slide(s) are typically evaluated by a cytotechnologist. This is the facility’s technical service, and is considered by Medicare and most other payers to be a clinical lab test rather than anatomical pathology. There are 14 codes listed in the AMA’s Current Procedural Terminology (CPT) text for the cytotechnologist’s initial screening. The correct charge is determined by a number of factors: the reporting system (i.e. conventional, Bethesda, thin prep); whether the evaluation is automated or manual; and whether or not an automated/manual rescreening was necessary. If the screener suspects an abnormality, or otherwise feels further evaluation is needed, the smear is then forwarded to the pathologist for physician review. Some of the more common technical codes include:
88142 - Cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation; manual screening under physician supervision 88164 – Cytopathology, slides, cervical or vaginal (the Bethesda System); manual screening under physician supervision 88175 – Cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation; with screening by automated system and manual rescreening or review, under physician supervision
Physician Services There is a single code used to report the professional/physician component of a pap smear:
88141 – Cytopathology, cervical or vaginal (any reporting system), requiring interpretation by physician
Use this charge, regardless of method, whenever the initial screener detects a problem that needs additional review. Even if the physician reports the smear as “negative” the charge is still billable. Keep in mind; however, that smears reviewed by the pathologist for quality control purposes only are not billable, nor can the pathologist bill 88141 if they are only acting as primary screener. In this case, report a standard screening code as appropriate. However, if an abnormality is detected and a diagnosis given, 88141 should be reported in addition to the screening code.
Ancillary Procedures If an HPV test is ordered this should be billed with CPT code 87621 (Infectious agent detection by nucleic acid (DNA or RNA); papillomavirus, human, amplified probe technique). If two separate tests are performed for high and low-risk HPV types, 87621 is reported for each. When a high-risk test returns positive, the specimen might be additionally tested for HPV types 16/18 to further determine the patient’s prognosis. This is also separately billable. To help ensure payment, be sure to use the correct abnormal pap smear diagnosis to support medical necessity for the HPV testing. Keep in mind that HPV tests are payable under the clinical lab fee schedule. There are no fees listed in Medicare’s physician fee schedule for these services.
APS has completely fulfilled all of our expectations, both in clinical pathology professional component billing and in all other areas of pathology billing.